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Lieb II JG, Draganov PV.Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis.
World J Gastroenterol 2007 July;13(26):3567-3574
Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis
Lieb II JG, Draganov PV.
Division of Gastroenterology, 1600 SW Archer Rd, Gainesville, FL 32610- 0214, United States. dragapv@medicine.ufl.edu
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The only way to prevent this complication is to avoid an ERCP all together. Because of the risks involved, a careful consideration should be given to the indication for ERCP and the potential risk/benefit ratio of the test. Once a decision to perform an ERCP is made, the procedure should be carried out with meticulous care by an experienced endoscopist, and with a minimum of pancreatic duct opacification. Several pharmacologic agents have been tested, but to date the most important method of reducing post ERCP pancreatitis is the placement of pancreatic stent. Pancreatic stents should be placed in all patients at high risk of this complication such as those undergoing pancreatic sphincterotomy, pancreatic duct manipulation and intervention, and patients with suspected sphincter of Oddi dysfunction. Pancreatic stents should be also considered in patients requiring precut sphincterotomy to gain biliary access. |
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